July 16, 2008

Though your doctor and dentist probably never mentioned this to you, there is strong evidence that gum disease may be either causing or worsening your diabetes.

Dr. Bernstein first wrote about how gum disease can raise blood sugars dramatically in the late 1990s in his first edition of Dr. Bernstein's Diabetes Solution . He recommended aggressive treatment of oral infections to lower blood sugar.

Now analysis of NHANES I data collected in the 1970s backs up the truth of his advice. A study of data collected about 9,296 nondiabetic male and female National Health and Nutrition Examination Survey (NHANES I) participants aged 25–74 years who completed a baseline dental examination (1971–1976) and had at least one follow-up evaluation (1982–1992) has shown a strong link between a diagnosis of gum disease and the subsequent development of diabetes. The study, published in the July issue of Diabetes Care, is:

The presence of any infection in the body can raise blood sugars, so it is possible that a gum infection might push an otherwise pre-diabetic blood sugar into the diabetic range. Once blood sugars reach that diabetic range they are high enough to damage the beta cells, causing further blood sugar deterioration.

Gum disease has also been associated with elevated CRP--a measure of overall inflammation in the body which also correlates with a higher risk of heart disease. This should be is very important to people with diabets since heart disease is beginning to look very much like an inflammatory disease. If you have not had your CRP measured, ask for it to be tested at your next doctor's appointment. If you have an abnormally high CRP you are much more likely to have inflammed arteries and may be one of the few people who benefit from the antiinflammatory effects of statin drugs. (People without elevated CRP are not likely to get any benefit from statins as their sole proven effect against heart disease seems to be that they reduce inflammation in the arteries.)

Dr. Bernstein explains that gum disease may also be the effect, not necessarily the cause, of high blood sugars. Given the very high blood sugars that were required for doctors to diagnose diabetes in the 1970s, it is very possible that many of the people with gum disease considered "nondiabetic" in this NHANES I study actually had undiagnosed diabetes.

More importantly, Dr. Bernstein argues that treating gum disease or any other dental infection can lower blood sugars significantly. He recommends the long-term use of antibiotics to treat stubborn oral infections.

If you have been taking a relaxed approach to early signs of gum disease as many of us do, and treating it only with infrequent cleanings and scalings, this finding should motivate you to demand more aggressive treatment from your dentist. For starters, life is a lot more fun when you have teeth. Taking a relaxed approach to gum disease is the number one way to guarantee that you won't have those teeth by the time you reach your 60s.

If you are a younger person, you can do a lot to prevent the development of gum disease by flossing your teeth daily. It's a simple thing to do but very effective. I started flossing in my early 30s after seeing a coworker lose all his teeth in his mid-40s. Almost 30 years later, my dentist can find no evidence of gum disease in my mouth, despite my going through many years of undiagnosed diabetes. Flossing is far more effective than brushing in preventing both cavities and gum disease. Make it a daily habit and your blood sugars will thank you!

Dr. Bernstein also suggests that if you see a sudden spike in your blood sugar that lasts for more than a few days can't be explained by any other cause, head to your dentist to make sure you don't have a gum or tooth infection.

I am very obsessive about oral hygiene. I highly recommend the crest spinbrush - the vibration really breaks up gunk, making flossing almost absolete. It's like a dentists clean (no, I am not paid to say that LOL).

Personally I tend to believe that gum infections are probably a sign of early diabetes. Like candida infections, or like a sore that does not heal...the immune/healing system goes to pot when cells aren't getting proper energy because of diabetes. Of course I remain open to the possibility that specific pathogens in the mouth can cause diabetes, I just think it is more likely that oral infections are a marker for a trend toward it.

I have had bad gums most of my life. They would bleed easily and getting my teeth cleaned was a painful ordeal. This changed as soon as I went on a gluten free diet 5 years ago. My gums now look healthy, don't bleed and dental cleaning is a breeze. It was not until 6 months ago that I realized my blood glucose was too high. Maybe getting my BG under control by lowering my carbs will further inprove my gums. I have a high CRP(this is dropping)and 8 yrs ago I had cardiac bypass. What role did my bad gums, high BG, low vitamin D and non-celiac gluten intolerance play in my health problems.

Yet another circular relationship, my gums and teeth both improved markedly with BG control. Which may be one reason the BG control became easier.Unfortunately my doctor tells me the accountants don't allow CRP test unless you have an inflammatory disease (duh!) and periodontal disease is not regarded as requiring antibiotics which are now being severely restricted for "trivial infections" (double duh!)Death By Accountant (sigh)

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.